Prevention: Why Does It Matter? Nancy Whitelaw, PhD Director, Center for Healthy Aging Senior Vice President National Council on Aging March, 2007

“Honest doc--if I had known I was gonna to live this long, I’d have taken better care of myself.”

We Face an Epidemic of Unparalleled Proportions More than 1.7 million Americans die of a chronic disease each year. One-third of the years of potential life lost before age 65 is due to chronic disease. Four chronic diseases—heart disease, cancer, stroke, and diabetes—cause almost two-thirds of all deaths each year. Mensah:

State of Aging and Health CDC/NCHS Health US, 2002 Leading Causes of Death Age 65+ “Medical Diagnoses” Heart Disease32% Cancer22% Stroke 8% Chronic respiratory 6% Flu/Pneumonia 3% Diabetes 3% Alzheimer’s 3%

Selected Chronic Conditions Age 65 and over by Sex, Data source: National Health Interview Survey Percent

Difficulty with IADLs or ADLs Percent of Medicare Beneficiaries by Age, 2002 Data source: Medicare Current Beneficiary Survey Percent

“Actual Causes of Death” Behavioral Risk Factors Behavior% of deaths, 2000  Smoking19%  Poor diet & nutrition/14% Physical inactivity  Alcohol 5%  Infections, pneumonia 4%  Racial, ethnic, economic ? Disparities McGinnis & Foege, JAMA, 1993; Mokdad et al, JAMA, 2004

Threats to Health and Well-being Among Seniors 73% age report no regular physical activity 81% age 75+ report no regular physical activity 61% - unhealthy weight 33% - fall each year 20% - clinically significant depression 35% - no flu shot in past 12 months 45% - no pneumococcal vaccine 20% - prescribed “unsuitable” medications

Total Cardiovascular Disease Deaths, 1999 (per 100,000 population) National Vital Statistics System, National Center for Health Statistics, CDC 190.5– – – –354.9 United States - 172

Variation in Heart Disease Rates, Why? 200% difference between high and low states Nearly 2/3 of the difference in death rates is explained by differences in modifiable risks  tobacco  overweight  high blood pressure  high cholesterol  physical inactivity  diabetes Byers et al. Prev Med, 1998

Disability by Age and Health Risk Progression of disability delayed approximately 7 years in low risk vs. high risk. Study of University of Pennsylvania Alumni Risk based upon BMI, smoking, exercise Note: A disability index of 0.1 = minimal disability. Vita et al. NEJM, 1998.

Chronic diseases account for 75% of the $1.4 trillion we spend on health care $245 billion an average of $1,066 per person 1980 $1.4 trillion an average of $5,039 per person 2001 Mensah: Heffler et al. Health Affairs, March/April $2.8 trillion an average of $9,216 per person 2011

Health Care Spending by Age Group, 2000 Rosen: Meara, White, and Cutler, Health Affairs, 2004

US Federal Spending in Billions, 2006

Life Expectancy by Health Care Spending Our nation spends more on health care than any other country in the world Mensah:

Growth of the Medicare Population Rosen:

Growth of the 85+ Population Rosen:

Prevention Works for Older Adults Longer life Reduced disability  Later onset  Fewer years of disability prior to death  Fewer falls Improved mental health  Positive effect on depressive symptoms  Possible delays in loss of cognitive function Lower health care costs

Challenges Confronting Prevention Ageism in health promotion and disease prevention Great disparities based upon race, ethnicity, income, location Science not shared – growing body of evidence of interventions that can positively impact health, disability and quality of life Untapped assets of 29,000 organizations currently reaching 7-10 million older adults Fragmented systems and services across aging, medical care, mental health and public health

Social Ecologic Model of Healthy Aging Individual Interpersonal Organizational Community Public Policy McLeroy et al. Health Educ Q, 1988; Sallis et al. Am J Prev Med, 1998

What the Social-Ecological Perspectives Says The health and well-being of older adults will be improved only if we work from a broad perspective. Comprehensive planning and partnerships at all levels are required. Harassing individuals about their bad habits has very little impact. Changes at the individual level will come with improvements at the organizational, community and policy levels.

NCOA’s Center for Healthy Aging Increase the quality and accessibility of health programming for older adults  Collaborate with diverse organizations to contribute to a broad-based national movement.  Identify, translate and disseminate evidence on what works – scientific studies and best practices.  Promote community organizations as essential agents for improving the health of older adults.  Advocate for greater support for strong and effective community programs.

Center for Healthy Aging National Resource Center on Evidence-based Prevention Evidence-based Model Health Programs Falls Free: National Falls Prevention Action Plan Moving Out: Best Practices in Physical Activity MD Link: Connecting Physicians to Model Health Programs New Connections: Partnerships between PH and Aging Get Connected: Partnerships between MH and Aging

Our Partners: Local and State Collaborations

Our Partners: Academics and Researchers Stanford University Healthy Aging Research Network including:  University of Washington  University of Illinois, Chicago  University of North Carolina  Texas A&M – Active for Life Initiative  West Virginia University UCLA & the Resource Centers on Minority Aging Research University of Illinois – Urbana Champaign Academic partners to state and local teams Center for the Advancement of Health

Our Partners: Strategy and Funding Atlantic Philanthropies Robert Wood Johnson Foundation The John A. Hartford Foundation of NY Administration on Aging Centers for Disease Control & Prevention Substance Abuse and Mental Health Services Administration Centers for Medicare and Medicaid Services Archstone Foundation Home Safety Council Merck Institute on Aging and Health

Learn More … Booth at the conference- just outside the Ballrooms Sessions throughout the conference – get a list at the booth. Visit our website: 

Prevention Works